Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A survey was conducted between 3 August and 5 October 2011 to test and evaluate the knowledge and attitudes of the military and civilian medical practitioners at the royal medical Service in the kingdom of Bahrain with regards to the clinical application of hyperbaric oxygen therapy. The survey consisted of a questionnaire and a semi-structured interview in which a total of 93 (out of a possible 302) medical practitioners were included (13 participated in the interviews). Similar to findings of previous studies, the knowledge of medical practitioners in Bahrain regarding hyperbaric oxygen therapy was low. Several practitioners were able to mention at least one indication for the therapy. No single factor had a statistically significant association with knowledge or the lack thereof. A large proportion of the participants had a positive attitude towards the use of hyperbaric oxygen therapy, felt that it is a valid treatment modality and they would refer their patients for such treatment. They would like to receive more information on hyperbaric oxygen therapy. Educational interventions to address the knowledge gap would likely be effective, since most participants have a positive attitude towards the therapy and believe that it is cost-effective.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This thesis focused on the provision of economic support to improve the outcomes of patients on TB treatment. Although the association between poverty and tuberculosis is generally acknowledged, there is little evidence to guide the use of economic interventions to improve tuberculosis control. In South Africa, a high burden country with extensive poverty, such evidence is particularly important. The first part of this thesis is a Cochrane systematic review of evidence from randomized controlled trials regarding the effectiveness of economic support among patients with tuberculosis. Eleven trials were included: ten conducted among marginalised groups in the United States on economic support for people on prophylactic treatment for latent TB; and one from Timor-Leste on economic support for patients with active TB. The review found that the use of economic interventions in patients with latent TB may increase the return rate for reading tuberculin skin test results, probably improves clinic re-attendance for initiation or continuation of prophylaxis and may improve completion of prophylaxis, compared to normal care. However, it is uncertain if economic support improves treatment completion in patients with active TB (low quality evidence). The second part of the thesis reports the findings of a pragmatic, cluster randomized controlled trial to evaluate the feasibility and effectiveness of delivering economic support to patients on treatment for active TB in South Africa. Patients with drug sensitive pulmonary TB were offered a monthly voucher valued at ZAR120 until completion of treatment or a maximum of eight months. Patients in control clinics received usual TB care. A parallel process evaluation provided contextual information to explain the trial findings. The qualitative component of this evaluation consisted of in-depth interviews with a sample of trial participants, including patients, nurses and health managers, to assess responses to the voucher and its administration. The quantitative component included a survey of patients’ household expenditure to assess patients’ levels of poverty and the effects of the voucher on these, and an analysis of the goods on which patients spent their vouchers. 4091 patients were included in the trial: 1984 in the control arm (10 clinics) and 2107 in the intervention arm (10 clinics). Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (-1.2; 12.3%), p = 0.107). Fidelity to the intervention was low, partly because nurses preferred to issue vouchers based on perceived financial need, rather than on eligibility. Logistical difficulties in delivering vouchers to clinics also undermined fidelity. The vouchers did not significantly increase patients’ household expenditure, but were experienced by patients as helpful, especially in providing more food with which to take their tablets. Factors related to the administration of economic support may undermine its effectiveness in improving TB treatment outcomes. Further research is needed to explore how best to deliver such economic support to those eligible to receive it, particularly in low and middle income countries where the burden of tuberculosis is highest. / AFRIKAANSE OPSOMMING: Hierdie tesis was toegespits op die verlening van ekonomiese steun om die uitkomste van pasiënte op tuberkulose- (TB-) behandeling te verbeter. Hoewel die verband tussen armoede en TB in die algemeen erken word, is daar nie veel bewyse om die gebruik van ekonomiese intervensies ter verbetering van TB-beheer te staaf nie. In Suid-Afrika – ’n land met ’n hoë TB-las en wydverspreide armoede – is sulke bewyse veral belangrik. Die eerste deel van hierdie tesis behels ’n sistematiese Cochrane-oorweging van bewysmateriaal afkomstig van verewekansigde, gekontroleerde proewe oor die doeltreffendheid van ekonomiese steun aan pasiënte met tuberkulose. Altesame 11 proewe is ingesluit: Tien is gedoen onder gemarginaliseerde groepe in die Verenigde State met die fokus op ekonomiese ondersteuning aan mense wat profilaktiese behandeling vir latente TB ontvang het. Een, van Timor-Leste, was gefokus op ekonomiese ondersteuning aan pasiënte met aktiewe tuberkulose. Die ondersoek het aan die lig gebring dat, vergeleke met normale sorg, die gebruik van ekonomiese intervensies by pasiënte met latente tuberkulose tog die omdraaikoers vir die lees van tuberkulien-veltoetsresultate kan verhoog, waarskynlik hertoelating tot klinieke vir die inisiëring of voortsetting van profilakse verbeter, en die voltooiing van profilakse kan verbeter. Die tweede gedeelte van die tesis behels ’n verslag oor die bevindings van ’n pragmatiese, trosverewekansigde gekontroleerde proef, om te bepaal hoe doenlik en doeltreffend dit sou wees om ekonomiese steun te verleen aan pasiënte wat in Suid-Afrika vir aktiewe tuberkulose behandel word. Pasiënte met middelsensitiewe pulmonêre tuberkulose het tot en met die voltooiing van hul behandeling, of tot ’n maksimum van agt maande, ’n maandelikse koopbewys ter waarde van ZAR120 ontvang. Pasiënte in kontroleklinieke het die gewone TB-sorg ontvang. ’n Parallelle prosesevaluering het kontekstuele inligting voorsien ter verklaring van die bevindinge van die proef. Die kwalitatiewe komponent van hierdie evaluering het bestaan uit diepte-onderhoude met ’n steekproef van alle deelnemers aan die proefneming, insluitend pasiënte, verpleegpersoneel en gesondheidsbestuurders, om hul reaksies te bepaal op die koopbewys self sowel as op die administrasie daarvan. Die kwantitatiewe komponent het ’n opname oor pasiënte se huishoudelike besteding ingesluit, ter vasstelling van hul armoedevlak en die moontlike uitwerking van die koopbewys daarop, asook ’n ontleding van die goedere waarop pasiënte hul koopbewyse bestee het. Altesame 4 091 pasiënte is by die proef ingesluit – 1 984 in die kontrole-afdeling (10 klinieke) en 2 107 in die intervensie-afdeling (10 klinieke). ’n Voorneme-om-te-behandel- (ITT-) ontleding toon ’n klein dog nie-betekenisvolle verbetering in behandelingsuksessyfers in intervensieklinieke (intervensie 76,2%; kontrole 70,7%; risikoverskil 5,6% (-1,2; 12,3%), p = 0.107). Getrouheid aan die intervensie was laag – deels omdat verpleegkundiges verkies het om die koopbewyse op grond van veronderstelde finansiële behoeftigheid eerder as volgens die studiekriteria uit te deel. Die koopbewyse het nie pasiënte se huishoudelike besteding beduidend verhoog nie, maar pasiënte het dit wél as nuttig ervaar, veral omdat hulle daarmee meer kos kon koop om saam met hul pille in te neem. Faktore wat verband hou met die administrasie van ekonomiese ondersteuning kan die doeltreffendheid van sodanige steun in die verbetering van TB-behandelingsuitkomste ondermyn. Verdere navorsing word vereis om te verken wat die beste manier sou wees om sodanige ekonomiese steun te bied aan diegene wat daarvoor in aanmerking kom, veral in lae- en middel-inkomstelande, waar die TB-las die hoogste is.

Thesis (MScMedSc)-- Stellenbosch University, 2014. / ENGLISH ABSTRACT: The commercial and military deep diving environment is typically a low visibility environment, where dependence on the visual senses often needs to be replaced by a reliance on tactile senses. This thesis reviewed the current knowledge regarding neuropsychological manifestations of nitrogen narcosis and exposed a number of shortcomings in the current body of knowledge. In particular, the human performance effects of hyperbaric exposure on tactile perception and memory have not been systematically studied. It is further not clear, how exactly psychological factors (e.g. anxiety, mood states) and biographical factors (e.g. age, education, technical exposure, experience) might influence tactile perception and memory performance under conditions of hyperbaric exposure. The correlation between subjective experiences of narcosis, tactile performance, and psychological and biographical variables is also unknown. This study thus set out to investigate certain neuropsychological aspects of nitrogen narcosis, with special reference to tactile perception and memory, and to examine the relationships of tactile performance with other psychological and biographical factors. The effects of experimental hyperbaric exposure (EHE) on tactile (form) perception and tactile shape memory were examined by testing these functions at 6 ATA and 1 ATA, using a cross-over design where two groups completed the same tasks, in opposite sequence. The psychological variables included trait anxiety, transient mood states, and subjective ratings of narcosis, while the biographical variables included age, education, and previous technical exposure. The results demonstrated the detrimental effect of nitrogen narcosis on tactile form perception and manipulation, irrespective of the sequence of testing. It also demonstrated this effect on tactile form memory, although the sequence of testing also played a role here. Higher trait anxiety was associated with poorer recall, and tension was associated with a larger decrement in recall performance, while fatigue was associated with poorer task completion. Subjective experiences also played a role, where feelings of physical anxiety (i.e. increased arousal) were associated with better recall, and feelings of cognitive suppression (decreased arousal) were associated with a larger decrement in recall performance. Lower academic attainment was associated with poorer recall, while higher diving qualification was associated with better recall. Performance on the surface was a good predictor of performance at depth. Qualitative analysis rendered three themes, namely focus vs. distraction, following instructions, and shape memory. Psychometric properties of the subjective narcosis measure were also reported. Theoretical implications include support for the slowed information processing model when completing complex neuropsychological tasks, as well as support for the memory model, thus suggesting that this particular pattern of memory impairment occurs because encoding under narcosis produces a weaker memory trace than normal. Lastly, the study has a number of implications for industry. For example, divers need to compensate for slowed task completion by, firstly, planning more time to complete complex tasks, and secondly, by practicing those tasks prior to the actual deep dive (either on the surface or in shallow water). The need for using additional forms of recording of events or objects at depth, to aid memory encoding and subsequent recall at surface was also emphasised. / AFRIKAANSE OPSOMMING: Kommersieële en militêre duik vind dikwels plaas in ‘n omgewing met swak sig, waar duikers moet staatmaak op taktiele sintuie, eerder as op visuele sintuie. Die tesis begin met ‘n oorsig oor die huidige kennis rakende neurosielkundige verskynsels van stikstof narkose, en het ‘n aantal tekortkominge gevind. Meer spesifiek, die menslike faktor in die effek van hiperbariese druk op taktiese persepsie en geheue is nog nie sistematies bestudeer nie. Dit is verder nie duidelik presies hoe sielkundige faktore (angs, gemoedstoestande) en demografiese faktore (ouderdom, opvoeding, tegniese blootstelling, ondervinding) taktiele persepsie en geheue onder toestande van hiperbariese druk sou beïnvloed nie. The korrelasie tussen die subjektiewe ervaring van narkose, taktiele taakverigting, en sielkundige en biografiese veranderlikes is ook nie bekend nie. Die studie het verskeie neurosielkundige aspekte van stikstof narkose, met spesifieke verwysing na taktiele persepsie en geheue, sowel as die verhouding tussen taktiele prestasie en sielkundige en biografiese faktore ondersoek. Die effek van hiperbariese druk op taktiele persepsie en geheue is ondersoek deur hierdie funksies te toets by 6 en 1 ATA, deur middel van ‘n oorkruis studie ontwerp, waar twee groepe die take voltooi het, in teenoorgestelde volgorde. Die sielkundige veranderlikes het bestaan uit trek-angs, tydelike gemoedstoestande, en die subjektiewe evaluering van narkose, terwyl die biografiese veranderlikes ouderdom, opvoeding, en vorige tegniese blootstelling ingesluit het. Die resultate het die nadelige effek van stikstof narkose op taktiele vorm persepsie en manipulasie gedemonstreer, ongeag die rigting van toetsing. Dit het ook hierdie effek op taktiele vorm geheue gedemonstreer, hoewel die rigting van toetsing wel hier ‘n rol gespeel het. Hoër trek-angs was geassosieër met swakker herroeping, en spanning met ‘n groter agteruitgang in herroeping, terwyl matheid geassosieer was met swakker taakvoltooiing. Subjektiewe ervarings het ook ‘n rol gespeel, met ervarings van fisiese spanning (verhoogde opwekking) geassosieer met beter herroeping, en ervarings van kognitiewe onderdrukking (verlaagde opwekking) met groter agteruitgang in herroeping. Laer akademiese kwalifikasie was geassosieer met swakker herroeping, terwyl hoër duik kwalifikasie geassosieer was met beter herroeping. Taakverrigting op die oppervlak was ‘n goeie voorspeller van prestasie op diepte. Kwalitatiewe analiese het drie temas geidentifiseer, naamlik fokus vs. afleibaarheid, die volg van instruksies, en vorm geheue. Die psigometriese eienskappe van die subjektiewe narkose meetinstrument is ook gerapporteer. Teoretiese implikasies van die studie sluit in ondersteuning vir die vertraagde prosesseringsmodel, wanneer komplekse neurosielkundige take voltooi word, sowel as ondersteuning vir die model vir hierdie spesifieke herroepingspatroon wat ‘n swakker geheuespoor laat wanneer enkodering plaasvind onder toestande van narkose. Die studie het ook praktiese implikasies vir industrie. Dit is byvoorbeeld nodig om te kompenseer vir vertraagde taakvoltooïng deur, eerstens, die beplanning vir meer tyd om komplekse take te voltooi, en tweedens, deur daardie take te oefen voor die diep duik plaasvind. Die noodsaaklikheid vir additionele maniere om gebeure of voorwerpe op diepte vas te lê is ook beklemtoon.

Background Hypertension is a global health burden affecting developed and developing countries, and South Africa is no exception (Seedat, Croasdale, Milne, Opie, Atkinson, Rayner and Veriava, 2006). In 2003, hypertension was estimated to have caused 7.1 million premature deaths and accounted for 4.5% of the disease burden worldwide (Lippincott and Wilkins, 2003). In 2001, non-communicable diseases accounted for almost 60% of the 56 million deaths annually and 47% of the global burden of disease. In countries such as Nigeria, Ghana and South Africa, the prevalence of chronic diseases is increasing, while the threat of communicable and poverty-related diseases (infant mortality, cholera and malnutrition) still exists (Belue, Okotor, Iwelunmor, Taylor, Degboe, Agyemang and Ogedegbe, 2009). Purpose The purpose of this study was to explore the compliance of hypertensive clients to lifestyle modification practices within a selected community in Durban, and to make recommendations for a structured programme of health promotion, through lifestyle modification. Method A quantitative approach was adopted to explore the compliance to lifestyle modification amongst hypertensive clients, and purposive sampling was used. Data collection was through a structured, self-administered questionnaire. A total of 205 participants completed the questionnaires. The questionnaire was divided into nine sections: Section A was on biographic data, Section B referred to compliance with lifestyle modification, and Sections C- I dealt with health belief model constructs. A four-point Likert scale was used to assess the health belief model constructs. Results Results revealed that 90% of the respondents in the study had a good understanding of the benefits of complying with their doctor’s treatment and the recommended lifestyle modification practices. They also possessed good knowledge and understanding about their condition, a factor which made them more compliant with lifestyle modification practices. The majority of respondents viewed health information shared through TV and radio programmes as motivators that helped them to comply with lifestyle modifications, and cited long waiting periods in the clinic and insufficient time to engage in physical activities as barriers to their lifestyle modification. Recommendations Health education campaigns and structured programmes of health promotion concerning lifestyle modification practices should be emphasized, especially with regard to diet and exercise. Foods containing high amounts of animal fats and fast foods should be avoided, and the importance of doing physical activities for 30 minutes at least three times a week should be emphasized. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Thesis (MScMedSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction: Tuberculosis (TB) treatment registers and laboratory records are essential recording and reporting tools in TB control programmes. Reliable data are essential for any TB control programme but under-registration of TB cases has been well documented internationally, due to under-reporting of patients on treatment or failure to initiate treatment. The accuracy and completeness of routinely collected data are seldom monitored. Aim: This study used record linking to assess the accuracy and completeness of TB treatment register data and the feasibility of estimating the completeness of bacteriological confirmed pulmonary TB registration in two high incident communities in South Africa with capturerecapture methods. Methods: All cases of bacteriologically confirmed TB defined as 2 smear-positive results and/or at least one culture-positive result were included. Record linking was performed between three data sources: (1) TB treatment registers; and (2) all smear and culture results from (a) the nearest central laboratory, and (b) the referral hospital laboratory. To estimate the completeness of TB treatment recording three-source log-linear capture-recapture models were used, with internal validity analysis. Results: The TB treatment registers had 435 TB cases recorded of which 204 (47%) were bacteriologically confirmed cases. An additional 39 cases that were recorded as nonbacteriological cases in the TB treatment register, were reclassified as bacteriologically confirmed. In addition, there were 63 bacteriologically confirmed cases identified from the laboratory databases which were not recorded in the TB treatment register. The final total number of bacteriologically confirmed TB cases across all 3 databases was 306, an increase of 50% over what had initially been recorded in the TB treatment register. The log-linear capture-recapture model estimated the number of bacteriologically confirmed TB cases not found in any of the data sources at 20, resulting in a total number of bacteriologically confirmed TB cases of 326 (95% CI 314-355). The completeness of registration of bacteriologically confirmed pulmonary TB cases was 79% after record linking and 75% after the capture-recapture estimate. Conclusions: The results presented in this thesis highlighted the concern regarding the accuracy and completeness of routinely collected TB recording and reporting data. A high percentage of bacteriologically confirmed cases from both laboratories were not recorded in the TB treatment registers. Capture-recapture can be useful, but not essential, for evaluation of TB control programmes, also in resource-limited settings, but methodology and results should be carefully assessed. The present study estimated the extent of the problem of underreporting of TB in South Africa and identified challenges in the process. Interventions to reduce underreporting of TB are urgently needed. / AFRIKAANSE OPSOMMING: Inleiding: Registers van tuberkulose (TB) behandeling en laboratoriumrekords is noodsaaklike instrumente in die dokumentering van en verslagdoening oor TB beheerprogramme. Betroubare data is onontbeerlik vir enige TB beheerprogram maar onderregistrasie van TB gevalle is internasionaal goed gedokumenteer. Die akkuraatheid en volledigheid van roetine data word selde gemoniteer. Doel: Hierdie studie het rekordkoppeling gebruik om die akkuraatheid en volledigheid van data in TB behandelingsregisters te ondersoek. Voorts is die uitvoerbaarheid van die vangshervangsmetodes vir die beoordeling van die volledigheid van bakteriologies bevestigde pulmonale TB registrasie in twee hoë-insidensie gemeenskappe ondersoek. Metodes: Alle gevalle van bakteriologies bevestigde TB, gedefinieer as 2 smeer-positiewe resultate en/of ten minste een kultuur-positiewe resultaat, is in die studie ingesluit. Rekordkoppeling is onderneem tussen drie databronne: (1) TB behandelingsregisters; en (2) alle smeer- en kultuurpositiewe resultate van (a) die naaste sentrale laboratorium, en (b) die verwysende hospitaallaboratorium. Om die volledigheid van TB behandelingsrekords te ondersoek is drie-bron log-lineêre vangs-hervangs modelle gebruik met interne geldigheidsontleding. Resultate: Die TB registers het 435 aangetekende TB gevalle bevat waarvan 204 (47%) bakteriologies bevestigde gevalle was. 'n Bykomende 39 gevalle wat as nie-bakteriologies bevestigde gevalle aangeteken was in die TB register is hergeklassifiseer as bakteriologies bevestig. Daar is ook 63 bakteriologies bevestigde gevalle geïdentifiseer vanuit die laboratorium databasisse wat nie in die TB register aangeteken was nie. Die finale totale aantal bakteriologies bevestigede TB gevalle oor al drie databasisse heen was 306, 'n toename van 50% in vergelyking met wat aanvanklik in die TB register aangeteken was. Die log-lineêre vangs-hervangs model het die aantal bakteriologies bevestigde gevalle wat nie in enige van die databronne gevind kon word nie as 20 gevalle geskat, wat gelei het tot 'n totaal van 326 (95% VI 314-355) bakteriologies bevestigde gevalle. Die volledigheid van registrasie van bakteriologies bevestigde TB gevalle was 79% na rekordkoppeling en 75% na die vangs-hervangs skatting. Gevolgtrekkings: Die resultate wat in hierdie tesis voorgelê is beklemtoon die besorgdheid oor die akkuraatheid en volledigheid van die aanmelding en optekening van roetine TB data. 'n Hoë persentasie van bakteriologies bevestigde gevalle van beide laboratoriums is nie in die TB register opgeteken nie. Vangs-hervangs kan nuttig wees, maar nie noodsaaklik nie, in die evaluasie van TB beheerprogramme, ook in hulpbron-arm omgewings, maar die metodologie moet omsigtig beoordeel word. Die huidige studie het die omvang van die probleem van onderrapportering van TB in Suid-Afrika beraam en uitdagings in die proses geïdentifiseer. Intervensies om onderrapportering te verminder word dringend benodig.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The long waiting lists for general anaesthesia and sedation services for children with Early Childhood Caries (ECC) at the Tygerberg Oral Health Centre highlighted the problem of ECC in this area. This was confirmed by a retrospective study of patient records at the Centre. ECC is largely caused by a combination of lifestyle factors, especially feeding and oral hygiene practices. Socio-economic status and parental factors such as education and employment have also been shown to play a role in the development of ECC. In order to address this problem, a study was designed to determine the prevalence of ECC in children from the lower socio-economic communities which drain to the Tygerberg Oral Health Centre and assess the knowledge of the caregivers of these children. A total of 659 children were examined at crèches and schools as well as community health clinics. The children examined at the clinics accompanied others and did not have any health reason for the visit themselves. As the aetiology is largely behaviour-driven and children are dependent on their caregivers to meet their basic needs, 366 caregivers attending the community health clinics with their children, were interviewed to determine their practices and knowledge of oral health. A total of 83 health care workers at these clinics were also interviewed to assess their knowledge of oral health matters and determine the role that they can play in the prevention of this disease. A cross-sectional community survey was carried out by means of clinical assessments and structured interviews with the aid of questionnaires. The survey was divided into 3 parts: 1. Prevalence of ECC amongst the children 2. Knowledge of the caregivers about oral health care 3. Knowledge of health care workers at the clinics in these communities about ECC The prevalence study revealed that 71.6% of children in the study population presented with caries. This is extremely high and highlights the need for serious interventions. Parents/ caregivers were shown to be ill-informed regarding their children’s oral health care needs which include dietary and oral hygiene practices as well as how this disease can be prevented. It is clear that caregivers need to be educated regarding feeding practices, weaning time, dietary content and the importance of basic oral health. The importance of preserving the primary dentition and regular dental attendance also needs to be emphasized in this community where dental health does not seem to be a priority. Health care workers such as nurses who come into contact with children from an early age would be the ideal vehicle to impart this information. However, as revealed from the results of this study, there is a serious lack of knowledge amongst these professionals regarding oral health matters. Time and resources therefore have to be invested to improve their knowledge and lessen their load so that more emphasis can be placed on prevention. Small changes can make a big difference towards addressing the burden of this disease on the health care system. / AFRIKAANSE OPSOMMING: Die lang waglyste vir algemene narkose en sedasiedienste vir kinders met Vroeë Kinderkaries (VKK) by die Tygerberg Mondgesondheid Sentrum het die probleem van VKK in die area uitgelig. Dit is bevestig deur 'n retrospektiewe studie van pasiënterekords by die Sentrum. VKK word grootliks veroorsaak deur 'n kombinasie van lewenstyl- faktore, veral voeding en mondhigiëne praktyke. Daar is ook aangetoon dat sosio-ekonomiese status en ouerlike faktore soos opvoeding en werkstatus 'n rol speel in die ontwikkeling van VKK. In 'n poging om hierdie probleem aan te spreek is 'n studie onderneem om die prevalensie van VKK in kinders van laer sosio-ekonomiese gemeenskappe wat van die Tygerberg Mondgesondheid Sentrum gebruikmaak te bepaal. Die kennis van mondgesondheid van die vernaamste toesighouers van die kinders in die studie is ook bepaal. 'n Totaal van 659 kinders is by crèches en skole sowel as gemeenskapsklinieke ondersoek. Die kinders wat by die klinieke ondersoek is, het nie self 'n gesondheidsrede vir die besoek gehad nie maar het saam met ander mense gekom. Die etiologie van VKK word hoofsaaklik deur gedrag gedryf en kinders is van hulle toesighouers afhanklik vir hulle basiese behoeftes. Dus is 366 toesighouers wat gemeenskapsklinieke besoek het ondervra oor hulle praktyke en kennis rakende mondgesondheid. 'n Totaal van 83 gesondheidswerkers by die klinieke is ook ondervra oor hulle kennis van mondgesondheid om die rol wat hulle kan speel in die voorkoming van hierdie siekte te ondersoek. 'n Dwarsdeursnit gemeenskaps-opname is uitgevoer deur middel van kliniese ondesoeke en gestruktureerde onderhoude met behulp van vraelyste. Die opname is in drie dele aangepak: 1. Prevalensie van VKK onder die kinders 2. Kennis van die toesighouers oor mondgesondheidsorg 3. Kennis van gesondheidsorgwerkers by die klinieke in hierdie gemeenskappe oor VKK Die prevalensiestudie het getoon dat 71% van kinders in die studiepopulasie karies gehad het. Dit is baie hoog en het die behoefte aan ernstige ingryping beklemtoon. Ouers/ toesighouers het geblyk om baie swak ingelig te wees oor hulle kinders se mondgesondheid-behoeftes wat dieet- en mondhigiëne praktyke ingesluit het, asook hoe die siekte voorkom kan word. Dit is duidelik dat versorgers onderrig moet word oor voedingspraktyke, die beste tyd vir soog, dieetinhoud en die belang van basiese mondgesondheid. Die belang van die behoud van primêre dentisie en gereelde tandsorgafsprake behoort ook in hierdie geneemskappe beklemtoon te word, gesien in die lig van die lae prioriteit wat hierdie gemeenskappe op mondgesondheid plaas. Gesondheidsorgwerkers soos verpleegpersoneel wat reeds in kontak kom met hierdie kinders op 'n jong ouderdom is die ideale persone om sulke inligting te versprei. Dit het egter uit die studie geblyk dat daar 'n ernstige gebrek aan kennis by hierdie professionele persone bestaan oor mondgesondheid. Tyd en hulpbronne sal belê moet word en hulle werkslading verlig moet word om hulle kennis te verbeter sodat meer klem op voorkoming gelê kan word. Klein veranderinge kan 'n groot verskil maak om hierdie siektelas op die gesondheidsorgstelsel te verlig.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: In developing countries the increasing number of the aged are often viewed as a problem. In particular, the indigent elderly residing in poor urban areas are at risk of becoming marginalised and underserved. The Western Cape has the third largest elderly population in proportion to the total population in the country. Social assistance in the form of a monthly pension is paid out to all elderly who pass a national means test carried out by South African Social Security Agency (SASSA). An assessment of the characteristics and health status of the elderly collecting old age pensions living in low-income urban poor communities in the City of Cape Town was carried out at pension pay points across four communities, i.e. Gugulethu, Khayelitsha, Mitchells Plain and Bonteheuwel. In community health surveys, choices regarding the methodology have to be made that can have profound effects on the study design and study outcomes. The milieu of the present study is one of urban poverty and specifically those urban elderly who qualify for non-contributory pensions (also called social cash transfers or government grants). The paucity of existing community-based studies on old-age pensioners in the City of Cape Town meant that a cross-sectional survey with wide-ranging coverage of demographic, social and health factors was the most logical design to employ in order to determine the extent of present needs and generate hypotheses for further controlled studies. A systematic random sample of 703 elderly was drawn at nine pension pay-out points in Cape Town Metropole. No pensioners refused to participate in the study. Structured interviews were carried out covering demographics, number of dependents, living conditions, socioeconomic circumstances, health status and needs and utilisation of health services. A reported 43% of participants lived in shacks and 88% reported regularly eating less than 3 meals a day. Eighty-seven percent of respondents reported waiting 3 hours or longer for medication at a clinic while 90% reported being dissatisfied with the service at their clinic. Fifty-eight percent of pensioners reported not being able to see well while 83% did not know where to get their eyes tested. Almost 70% of pensioners said that they have been ill-treated by a family member and 64% scored as severely depressed on the geriatric depression scale. In this study, 266 pensioners solely supported 471 children of which 65 (14%) were disabled children. In 95% of cases the pensioner does not receive any support from the child's parents. The study found that the elderly on a state grant had considerable unmet health needs and required assistance with activities of daily living. The indigent pensioners in this study bore a huge duty of care for minor children as custodial grandparents while not receiving a high level of health support themselves. / AFRIKAANSE OPSOMMING: Die toenemende aantal bejaardes word dikwels in ontwikkelende lande as 'n probleem gesien. In die besonder loop die bejaardes wat in lae-inkomste stedelike gebiede woon die risiko om gemarginaliseer te word en swak dienslewering te ondervind. Die Wes-Kaap het die derde grootste populasie van bejaardes in verhouding tot die totale bevolking in die provinsie. Sosiale bystand in die vorm van 'n maandelikse pensioen word betaal aan alle bejaardes wat die inkomstetoets slaag wat deur die Suid-Afrikaanse Agentskap vir Maatskaplike Sekerheid (SAAMS) uitgevoer word. 'n Ondersoek na die eienskappe en gesondheidstatus van bejaardes wat hulle ouderdomspensioene in lae-inkomste stedelike gemeenskappe in die Stad Kaapstad kom afhaal is uitgevoer. Die studie is gedoen by pensioen-uitbetaalpunte in vier gemeenskappe, naamlik Gugulethu, Khayelitsha, Mitchells Plein and Bonteheuwel. In gemeenskapsgesondheid-opnames moet keuses gemaak word ten opsigte van die metodologie wat diepgaande gevolge vir die studieontwerp en -uitkomste kan inhou. Die milieu van die huidige studie in dié van stedelike armoede en spesifiek die leefruimte van stedelike bejaardes wat kwalifiseer vir nie-bydraende pensioene (ook genoem sosiale kontantoordragte of staatstoelaes). Die gebrek aan bestaande studies van ouderdomspensioenarisse in Kaapstad het beteken dat 'n dwarsdeursnit-opname van die demografie, sosiale en gesondheidsfaktore die mees logiese ontwerp was om uit te voer. Dit is gedoen om die omvang van huidige behoeftes te bepaal en verdere hipoteses te genereer wat deur vergelykende studies ondersoek behoort te word. 'n Stelselmatige ewekansige steekproef van 703 bejaardes is getrek by nege betaalpunte in die Kaapse stadsgebied. Geen proefpersone het geweier om deel te neem nie. Gestruktureerde onderhoude is gevoer wat die volgende aspekte gedek het: demografiese eienskappe, aantal afhanklikes, gesondheidstatus en benutting van gesondheidsdienste. Van die deelnemers het 43% in informele behuising ("shacks") gewoon en 88% het gerapporteer dat hulle gereeld minder as 3 daaglikse maaltye eet. Daar het 87% gerapporteer dat hulle 3 uur of langer gewag het om medikasie by hulle plaaslike kliniek te ontvang terwyl 90% ontevrede was met die diens wat hulle by die kliniek ontvang het. Daar het 58% van die bejaardes gerapporteer dat hulle nie goed kan sien nie terwyl 83% van hulle nie geweet het waar hulle hulle oë kan laat toets nie. Omtrent 70% van bejaardes het gesê dat hulle deur 'n familielid mishandel word en 64% kon as ernstig depressief geklassifiseer word op die geriatriese depressieskaal. In hierdie studie was 266 pensioenarisse die enigste sorg en voog van 471 kinders van wie 65 (14%) gestremd was. In 95% van gevalle het die pensionaris geen geldelike of ander bydraes van die kind(ers) se ouers ontvang nie. Die studie het bevind dat bejaardes wat 'n staatstoelaag ontvang aansienlike onvervulde gesondheidsbehoeftes het en hulp benodig met aktiwiteite van daaglikse bestaan. Die behoeftige pensioenarisse in hierdie studie het 'n groot las gedra aan die versorging van minderjarige kinders as toesighoudende grootouers ("custodial grandparents") terwyl hulleself nie 'n hoë vlak van ondersteuning geniet nie.

Thesis (MScMedSc)-- Stellenbosch University, 2014. / ENGLISH ABSTRACT: Diving medical doctors frequently make use of Hyperbaric Facilities without fully realising their legal and ethical responsibilities towards the safety of their patients and their staff. Few have specific training in the technical or operational aspects of these facilities; this deficiency is exacerbated when these are established in remote areas. The potential dangers are real and the results can be devastating. Most current regulatory, manufacturing, safety and operational guidance documents are not flexible enough to be applied universally, nor do they offer practical guidance on the recognition and the mitigation of the unique and relevant hazards at a given facility. The goal of integrated safety is rarely achieved. The Risk Assessment Guide (RAG) was developed by the investigator as a tool to qualify the actual safety status of a hyperbaric facility and to offer guidance on how to improve and maintain it. Although the RAG has been subject to extensive peer review and field implementation over the past 13 years, it has not been subject to scientific validation. Therefore, the objective of this thesis was to do so by (1) retrospectively reviewing the most common safety concerns affecting facility status as identified by the RAG; (2) using the data derived from the analysis to produce a predictive model of likely safety status for un-assessed facilities; and (3) consolidating the results in the form of specific recommendations to improve and maintain safety status. Data collected from a consistent application of the RAG over a period of 13 years, covering 105 applicable facilities, was analysed to determine the common safety concerns, particularly those affecting safety status by means of a consolidated Risk Assessment Score (RAS). The RAS values permitted comparisons between the facilities assessed. The various factors associated with a higher RAS were determined by means of a multivariate regression. Thereupon, the most significant determinant factors were built into a predictive model for the likely safety status of an un-assessed facility. Finally, the most common safety concerns were identified and summarised so that medical practitioners are empowered to determine, improve and maintain the safety status of a given facility. The conclusions of this project are that: (1) the RAG is an appropriate tool to assess facilities for risk elements relevant to their safety status while simultaneously filling the knowledge gaps to equip medical practitioners and staff to improve and maintain safety; (2) reliable predictions on unknown facilities can be made to provide medical practitioners with the necessary information on whether a given facility is appropriate for patient referral; and (3) the RAG is a suitable benchmark for determining hyperbaric facility safety; the review of its application has provided objective data that will permit the formulation of future safety guidelines based on empirical rather than arbitrary information. / AFRIKAANSE OPSOMMING: Duikmediese dokters maak dikwels gebruik van hiperbariese fasiliteite sonder om die wetlike en etiese verantwoordelikhede ten opsigte van die veiligheid van hul pasiënte en personeel te besef. Weinig het spesifieke opleiding in die tegniese of operasionele aspekte van hierdie fasiliteite; hierdie tekort is gewoonlik erger in afgeleë gebiede. Die potensiële gevare is wesenlik en die gevolge kan verwoestend wees. Meeste van die huidige regulatoriese-, vervaardigings-, veiligheids en operasionele leidingsdokumente is nie buigsaam genoeg om in die algemeen toegepas te kan word nie. Hulle bied ook nie praktiese leiding oor die erkenning en die versagting van unieke en relevante gevare by 'n gegewe fasiliteit nie. Die doelwit van geïntegreerde veiligheid word selde bereik. Die “Risk Asssessment Guide” (RAG) is voorheen deur die navorser ontwikkel as 'n instrument om die werklike veiligheidsstatus van 'n hiperbariese fasiliteit te kwantifiseer en leiding te bied oor hoe om dit te verbeter en in stand te hou. Alhoewel die RAG onderhewig was aan uitgebreide eweknie hersiening en praktiese uitvoering oor die afgelope 13 jaar, was dit nie voorheen onderhewig aan wetenskaplike validasie nie. Die doelwit van hierdie tesis is dus om hierdie te bewerkstellig deur (1) die mees algemene veiligheidskommernisse wat fasiliteitstatus beïnvloed, soos deur die RAG geïdentifiseer, retrospektiewelik te hersien; (2) die data wat deur die hersiening verkry is te gebruik om 'n model te ontwikkel vir onbeoordeelde fasiliteite, wat die waarskynlike veiligheidsstatus kan voorspel, en (3) die resultate te konsolideer in die vorm van spesifieke aanbevelings om veiligheidsstatus te verbeter en in stand te hou. Die data wat ingesamel is deur die konsekwente toepassing van die RAG oor 'n tydperk van 13 jaar en wat 105 fasiliteite gedek het, is ontleed om die algemene veiligheidskommernisse, veral die wat die veiligheidsstatus beïnvloed, deur middel van 'n gekonsolideerde Risikoassesserings waarde (RAW) te bepaal. Die duidelike en aangepaste RAW laat toe om vergelykings tussen die fasiliteite te tref. Faktore wat verband hou met 'n hoër RAW was deur middel van 'n meervoudige regressie bepaal. Daarna is die belangrikste determinante in 'n voorspellende model gebou om die waarskynlike veiligheidsstatus van 'n onbeoordeelde fasiliteit te bepaal. Ten slotte was die mees algemene veiligheidskommernisse geïdentifiseer en opgesom om sodoende mediese praktisyns te bemagtig om die veiligheidsstatus van 'n gegewe fasiliteit vas te stel, te verbeter en in stand te hou. Die gevolgtrekkings van hierdie projek is dat: (1) die RAG 'n geskikte instrument is om fasiliteite te evalueer vir risiko-elemente wat relevant is tot hul eie veiligheidsstatus en terselfdertyd die kennisgapings te vul om geneeshere en personeel toe te rus om veiligheid te verbeter en in stand te hou; (2) redelik betroubare voorspellings oor onbekende fasiliteite kan gemaak word om vir mediese praktisyns die nodige inligting te verskaf aangaande die geskiktheid van 'n gegewe fasiliteit vir pasiënt-verwysing, en (3) dat die RAG 'n geskikte maatstaf is vir die bepaling van hiperbariese fasiliteit veiligheid. Die hersiening van die toepassing het objektiewe data voorsien wat die formulering van toekomstige veiligheidsriglyne, geskoei op empiriese eerder as arbitrêre inligting, sal toelaat.

No abstract available. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying ‘backyard dwellings’ on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards. The study population was classified as ‘young’ - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment. Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health that was envisaged at its inception. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor. / AFRIKAANSE OPSOMMING: Suid-Afrika is besig met 'n ambisieuse program om diegene wat in informele behuising woon te hervestig. Hierdie inisiatiewe is voorheen die HOP en tans die “BNG” programme genoem. Hierdie hervestigingsprogramme is gemik daarop om die lewensomstandighede van die stedelike armes en dus hulle gesondheid- en armoedestatus te verbeter. Hierdie laekoste huise is algou in byna alle nedersettings aangevul deur krotwonings in die agterplase. Die huidige studie is 'n epidemiologiese beoordeling van die gesondheid en sanitasiestatus van inwoners van spesifieke laekoste behuisingsgemeenskappe in die Stad Kaapstad in vergelyking met diegene wat krotwonings op dieselfde erwe bewoon. Die studie is onderneem in vier laekoste-behuising gemeenskappe geselekteer in die stadsgebied. 'n Gesondheid- en behuisingevaluasie tesame met 'n inspeksie van elke woning is uitgevoer in 336 ewekansig geselekteerde wonings wat 1080 inwoners gehuisves het. Die woonbuurte was Tafelsig, Masipumelela, Driftsands en Greenfields. Mikrobiologiese besoedelingsvlakke van oppervlak-afloopwater in hierdie gemeenskappe is bepaal deur middel van die bepaling van Escherichia coli vlakke (met behulp van ColilertTM Gedefinieerde Substraat Tegnologie) as aanduiding van gesondheidsgevare in die omgewing. Die studiepopulasie is as ‘jonk’ geklassifiseer - 43% was 20 jaar of jonger. Amper een-derde van die huishoudings het 'n enkelouer-vrou aan die hoof gehad. In al vier gemeenskappe gesamentlik het 47.3% van die huishoudings die een of ander vorm van maatskaplike toelae ontvang. Tydens inspeksie is 58% van die toilette op die erwe as "nie-funksioneel" bevind, terwyl al die huise substansiële strukturele skade getoon het - 99% van die huiseienaars het gerapporteer dat hulle nie herstelwerk aan hulle huise kan bekostig nie. In 32% van die wonings is daar een of meer gevalle van diarree gedurende die voorafgaande twee weke voor die opname gerapporteer. Vyf persent van die deelnemers het vrywillig gerapporteer dat hulle HIV positief was terwyl 11% gerapporteer het dat hulle TB positief was (een was Veelvuldige Middelweerstandige TB). Nie een van die HIV positiewe of TB positiewe persone was op enige behandeling nie. Die E. coli vlakke van die water op die erwe of sypaadjies het gewissel vanaf 750 to 1 580 000 000 organismes per 100 ml water - wat erge fekale besoedeling van die omgewing bevestig het. Die verbetering in gesondheid wat deur die hervestigingsproses voorsien is, het nie gematerialiseer vir die ontvangers van die laekoste-behuising in hierdie studie nie. Die kwesbaarheid van die gesondheid van die individue in hierdie gemeenskappe hou groot implikasies vir gesondheidsdienste in. Sanitasiefalings, infektiewe siektedruk en omgewingsbesoedeling hou groot openbare gesondheidsrisiko in. Die verdigting wat deur agterplaaskrotte meegebring word asook die gevolge vir munisipale dienste benodig beter bestuur. Beleide oor laekoste-behuising vir armes kort herbeplanning om die realiteite wat saamgaan met verdigting deur agterplaaskrotte te kan hanteer sodat die verwagte verbetering in gesondheid kan materialiseer. Hierdie is inderwaarheid 'n nasionale probleem wat omtrent alle staatsbefondste laekoste-behuising gemeenskappe in Suid-Afrika affekteer. Openbare gesondheid en stadsbeplanning behoort die skeiding tussen hierdie twee dissiplines te oorbrug om sodoende die ongelyke gesondheidstatus van die stedelike armes aan te spreek.